'When you hear hoofbeats, think of horses not zebras' - the old adage is well-known to GPs but what should you do when faced with a zebra, not a horse? Consultant cardiologist Professor Robert Tulloh and GP Dr Louise Tulloh kick off our new series with their advice on how to catch Kawasaki disease in general practice.

'Consistent message' can help boost uptake of MMR

A Scottish study revealing wide variation in MMR uptake rates between practices has highlighted PCO support and monitoring, practice organisation and social deprivation as key factors.

A public health team from Lothian health board looked at MMR and other immunisation rates for children aged two and under across Lothian, using data collected between 2000 and 2003.

MMR uptake in the area has fallen by 5 percentage points in that period and stood at 89.4 per cent in the year to March 2003.

Looking at social class differences, the researchers found uptake rates for MMR were lowest among deprived groups, standing at 92.0 per cent

in social classes 1 and 2,

compared with 86.5 per cent in social classes 6 and 7.

The researchers then focused on three local health care co-operatives (LHCCs) and eight GP practices, looking for factors that might explain variations in uptake rates.

'We wanted to ask what we could learn from the practices,' said Dr Janet Murray, a specialist registrar in public health and one of the investigators. 'We found that shared information and good teamwork are key. Practices can achieve high rates of immunisation despite the influence of deprivation.'

For example, one LHCC in the study has 50 per cent of its patients in social classes 5, 6 and 7. But uptake of MMR in this area is around the overall Lothian average for all groups.

Four factors were identified as contributing to improved immunisation rates on an organisational level. First, researchers said staff needed access to up-to-date information and training, so they can 'give advice with confidence'.

Second, practices with higher uptake rates had good communication between team members and delivered a consistent message to patients.

Third, there was great variation in the skill mix and the roles that different professionals played in different practices. Finally, proactive management involvement and monitoring of uptake rates at a PCO

level appeared to be helpful.

The results were presented at a Health Protection Agency meeting held earlier this month in Glasgow.

Dr James Cowan, an Edinburgh GP and member of the Lothian Immunisation Group, said: 'We accept that deprivation plays a part and we can't help feeling the issue is clouded by the media exposure on immunisation. But if you have a consistent and positive approach to the message it can increase uptake.'

Dr George Kassianos, RCGP immunisation spokesman and a GP in Bracknell, Berkshire, said: 'GPs and PCOs need to co-ordinate their campaign, backed up by the Department of Health.'